Cai Yifeng, Luo Jiaquan, Huang Junjun, Lian Chengjie, Zhou Hang, Yao Hao, Su Peiqiang
Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Int Orthop. 2016 Jun;40(6):1135-42. doi: 10.1007/s00264-016-3139-x. Epub 2016 Feb 24.
Our aim is to evaluate the safety and effectiveness of interspinous spacers versus posterior lumbar interbody fusion (PLIF) for degenerative lumbar spinal diseases.
A comprehensive literature search was performed using PubMed, Web of Science and Cochrane Library through September 2015. Included studies were performed according to eligibility criteria. Data of complication rate, post-operative back visual analogue scale (VAS) score, Oswestry Disability Index (ODI) score, estimated blood loss (EBL), operative time, length of hospital stay (LOS), range of motion (ROM) at the surgical, proximal and distal segments were extracted and analyzed.
Ten studies were selected from 177 citations. The pooled data demonstrated the interspinous spacers group had a lower estimated blood loss (weighted mean difference [WMD]: -175.66 ml; 95 % confidence interval [CI], -241.03 to -110.30; p < 0.00001), shorter operative time (WMD: -55.47 min; 95%CI, -74.29 to -36.65; p < 0.00001), larger range of motion (ROM) at the surgical segment (WMD: 3.97 degree; 95%CI, -3.24 to -1.91; p < 0.00001) and more limited ROM at the proximal segment (WMD: -2.58 degree; 95%CI, 2.48 to 5.47; p < 0.00001) after operation. Post-operative back VAS score, ODI score, length of hospital stay, complication rate and ROM at the distal segment showed no difference between the two groups.
Our meta-analysis suggested that interspinous spacers appear to be a safe and effective alternative to PLIF for selective patients with degenerative lumbar spinal diseases. However, more randomized controlled trials (RCT) are still needed to further confirm our results.
我们的目的是评估棘突间撑开器与后路腰椎椎间融合术（PLIF）治疗退变性腰椎疾病的安全性和有效性。
通过PubMed、科学网和Cochrane图书馆进行全面的文献检索，检索截至2015年9月的文献。纳入的研究根据纳入标准进行。提取并分析并发症发生率、术后腰部视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）评分、估计失血量（EBL）、手术时间、住院时间（LOS）以及手术节段、近端节段和远端节段的活动度（ROM）等数据。
从177篇文献中筛选出10项研究。汇总数据显示，棘突间撑开器组术后估计失血量更低（加权平均差[WMD]：-175.66 ml；95%置信区间[CI]，-241.03至-110.30；p＜0.00001），手术时间更短（WMD：-55.47分钟；95%CI，-74.29至-36.65；p＜0.00001），手术节段的活动度更大（WMD：3.97度；95%CI，-3.24至-1.91；p＜0.00001），近端节段的活动度更受限（WMD：-2.58度；95%CI，2.48至5.47；p＜0.00001）。两组术后腰部VAS评分、ODI评分、住院时间、并发症发生率以及远端节段的活动度无差异。
我们的荟萃分析表明，对于选择性的退变性腰椎疾病患者，棘突间撑开器似乎是PLIF的一种安全有效的替代方法。然而，仍需要更多的随机对照试验（RCT）来进一步证实我们的结果。
